| NPI | 1104378314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MARIE REISINGER Physician 505-980-8738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NM MD2011-0829) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2017-01-18 |